Prevalence of Coronavirus Disease 2019 in Rheumatic Patients and Evaluation of The Effect of Disease-Modifying Anti-Rheumatic Drugs

Abstract Background: One of the most controversial issues among rheumatologists is the best approach to managing a rheumatic patient (RP) with coronavirus disease 2019 (COVID-19).Objectives: This study aims to evaluate the prevalence of COVID-19 in RPs and compare it to thegeneral population (healthy individuals). Besides, it assesses the incidence of COVID-19 based on rheumatologic diseases (RDs) categories and immunosuppressive (IS) drug history.Methods: In a cross-sectional study, all RPs of the rheumatology clinic of Shahid BeheshtiHospital, Qom, Iran were included (the case group), and the prevalence of COVID-19 was compared to that in healthy individuals (the control group), between December 1, 2019, andFebruary 29, 2020. Qom city was the first city in Iran in which COVID-19 was identified and spread rapidly. The participants were recruited from hospital records for the case group and QomHealth Network’s database for the control group.Results: The prevalence of COVID-19 is significantly less in RPs than in the healthy population.Moreover, patients who were under treatment with biologic diseas-modifying anti-rheumatic drugs(DMARDs) and IS drugs had milder symptoms in the case of COVID-19. Two RPs died from COVID-19, both of whom had granulomatosis and polyangiitis (GPA).Conclusion: The prevalence of COVID-19 in the RPs was lower than the general population, which was determined to be associated with more adherence to the quarantine and social distancing rules by RPs. Besides, using leflunomide (a DMARD) and IS drugs might have a protective effect against severe COVID-19.